By Akhil Suresh
Mr. Patel, a sixty year old man, finds himself admitted to a hospital due to complications in his health. Surrounded by masked nurses and beeping machines, he starts to feel a deep sense of anxiety and uncertainty. His family gathers in the treatment room, seeking an update from the medical team. The doctor arrives, talks about his condition using complex jargon which leaves them confused and overwhelmed. “Have the prescribed medicines. Don’t worry.” The doctor summarised and rushed back to his office. As days and weeks pass by, Mr. Patel’s frustration grows. He feels increasingly disconnected from the decisions about his own health. This lack of clear communication and the absence of a shared understanding breeds mistrust and a sense of helplessness in Mr. Patel and his family.
This is not an experience we are unfamiliar with. Various researchers have identified communication breakdowns as a well-documented issue concerning the healthcare field. Inadequate communication between doctors and patients, as well as amongst different members of the treatment team is a frequent and potentially dangerous occurrence. But alarmingly, this is just one layer of the problem. Nicole F. Roberts (2017) in an article for Forbes points out how this medical mess is much more complicated and systemic than it appears at the outset. Hospitals are “notoriously competitive” and “vanquish any efforts of sharing and collaboration between systems or sites”, writes Roberts. “Researchers do not talk to each other”, “Policymakers do not talk to people”, “EHR’s do not talk to each other”, “No one talks to the Government”, “Media is not good at conveying Science”- these are some of the subtitles of Roberts’ article which are as frightening as they are insightful. The findings are sharp – a clear call to action for the healthcare field, and the governmental bodies regulating it.
Why Dialogue?
In a complicated field such as medicine, effective dialogue is as important as the intricacies of treatment and healing. 82% of patients surveyed by a medical indemnity provider stated the patients are unlikely to complain if their doctors communicated openly and with empathy (Touchpoints health, n.d.). “Communication breakdowns” has been identified as the leading factor contributing to all sentinel events as per the annual report of the 2022 Sentinel Events by the Joint Commission (2023). In ‘Dialogue 2019’, a two-day conference organised by the Mumbai Obstetric and Gynaecological Society, experts identified miscommunication between patients and doctors as a key cause of violence against doctors (Dabre, 2019). A “lack of communication and transparency among the different stakeholders” is also related to a massive financial and resource utilisation loss (Touchpoints health, n.d.; Agarwal et al, 2010).
Interventions such as the integration of social workers into teams of healthcare providers, collaboration with community workers, usage of digital resources, policy measures at the public level and efforts to build social awareness, are all recent advancements which have the potential to produce significant improvements in the overall situation. At the micro level, the effectiveness of protocols such as SPIKES (Mahendiran, 2023) is a very distinctive example of how miniature steps guide the transformation of bewildering challenges. These distinct triumphs, the maturation of digital resources and a heightened public demand, call for the adoption of a deeper transformatory approach both at the micro and macro levels within the healthcare field – a perfect opportunity for the Dialogic Method to substantiate its transformatory power.
At the Micro level
Dialogic skills have the potential to enhance the various interactions in the healthcare process. Through active listening and information sharing, patients understand and take part in the treatment process and the treatment team understands the context of the patient and the unique challenges they face. This empowers a collaboration in choosing the best course of action for the situation. Dialogue does more than just decision-making – it develops trust. Patients tend to stick to their treatment plan when they feel heard and understood.
Dialogue also makes sure that the interests of all stakeholders participating in the treatment process are addressed. This could include engaging family in discussions or facilitating connections with suitable support groups and thereby, contributing to the psychosocial wellbeing of the patient. With Dialogue supplementing the stethoscope as a tool, the providers of care can easily navigate the comorbid complexities of healing – be it communication difficulties, mistrust, treatment resistance, medical collusion, lack of adherence, family problems, or the various other social challenges that hinders the treatment process.
At the Macro level
Remember the terrifying days of the COVID-19 pandemic? Humanity wrestled with a virus, of which we knew little, facing a future wrapped in nothing but uncertainty. But, just in a few years time, we have resurrected from the depths of a collective psychic fear – not unharmed, but definitely transformed. We used a life-threatening pandemic as a fuel for our growth, and a significant part of that growth sprung from the use of a powerful tool – Dialogue!
In a matter of weeks global mask production skyrocketed tenfold, research findings were rigorously exchanged, vaccines were developed, telemedicine expanded, digital infrastructure strengthened, information sharing surged – all due to collaborations between governments, scientists, researchers, businesses, healthcare practitioners, engineers among the rest of humanity. And all it took was an aligned interest to tackle a common villain – one of microscopic size!
Imagine the public, healthcare practitioners, government, policymakers, businessmen, scientists, engineers and all relevant stakeholders, actively and regularly participating in the overall ecosystem of healthcare – understanding the overall picture, playing their roles mindfully, and advocating for their needs. This would transform the fragmented system defined by intense competition by nurturing in it, a spirit of collaboration and co-creation. The government and policymakers will be more in line with the needs of the public. Improved transparency would pave the way to a flourishing of public awareness and trust. Sharing of new knowledge and innovative ways to navigate challenges would contribute to the rapid development of the field.
A dialogic approach at the macro level within the healthcare system has the potential to solve the challenges faced by the public and healthcare practitioners, craft effective policies, allocate resources efficiently, integrate different treatment options, build public awareness, bridge financial gaps, harness digital resources, nourish medical business and ultimately cultivate a sustainable and ‘healthy’ healthcare ecosystem. Our fight against the pandemic serves as a powerful example from recent times for the healthcare system at large, elucidating the power of collaboration, co-creation, empathy, and an attitude of abundance – all hallmarks of a dialogic approach.
“To always comfort”
A healthcare system transformed by dialogue wouldn’t just address the practicalities of treatment; it would fundamentally change the healthcare experience. Every illness is, in a way, a call to adventure. The ideal physician, then, becomes a mentor on the patient’s journey towards healing. Let’s employ dialogue, and test its potential to birth brave heroes out of the patients in pain!
Dialogue won’t resolve all human problems and the Dialogic Method isn’t a replacement for existing strategies. It’s a very simple approach that builds upon and enhances them. It’s a humble framework built to empower people, and their processes. Following the spirit of Hippocrates, trying to “sometimes cure”, “often treat”, but “to always comfort”, let’s steer towards building a healthcare system which addresses the people within the patients and the fears beyond the physical, where Mr. Patel, and everyone else, feels informed, respected, and comforted.
References
Roberts, N. F. (2017). 10 ways lack of communication is ruining healthcare https://www.forbes.com/sites/nicolefisher/2017/05/02/10-ways-lack-of-communication-is-ruining-health-care/
Touchpoints Health. (n.d.) “Financial Costs of Communication Failures in Healthcare.” Touchpoints Health, https://www.touchpoints.health/post/financial-costs-of-communication-failures-in-healthcare
Joint Commission. (2023). Sentinel Event Data 2022 Annual Review. Retrieved from http://www.jointcommission.org/Sentinel_Event_Policy_and_Procedures/
Dabre, R. (2017). Miscommunication key cause of violence against doctors. The Hindu. https://www.thehindu.com/news/cities/mumbai/miscommunication-key-cause-of-violence-against-doctors/article26758785.ece
Agarwal, Ritu & Sands, Daniel & Schneider, Jorge. (2010). Quantifying the Economic Impact of Communication Inefficiencies in US Hospitals. Journal of healthcare management / American College of Healthcare Executives. 55. 265-81; discussion 281. 10.1097/00115514-201007000-00007
Mahendiran M, Yeung H, Rossi S, Khosravani H, Perri GA. Evaluating the Effectiveness of the SPIKES Model to Break Bad News – A Systematic Review. Am J Hosp Palliat Care. 2023 Nov;40(11):1231-1260. doi: 10.1177/10499091221146296. Epub 2023 Feb 13. PMID: 36779374.